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General NPI Number Information
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NPI Number | 1386770691
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Entity Type | Organization
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Legal Business Name | SOFYA TSYGANOVSKAYA MD INC.
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1411 W OLIVE AVE SUITE D&E
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City | BURBANK
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State | CA
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Zip | 91506-2427
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Country | US
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Telephone | 818-843-1884
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Fax | 818-843-4622
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Provider Business Mailing Address
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Address Line | PO BOX 5655
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City | GLENDALE
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State | CA
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Zip | 91221-5655
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Country | US
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Telephone | 818-559-7367
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Fax | 818-843-4622
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Authorized Official
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Title or Position | CEO
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Name | SOFYA TSYAGANOVSKAYA
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Credential |
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Telephone | 818-653-7931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A84551
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License Number State | CA
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